Syphilis in pregnancy: Difference between revisions
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==Background== |
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*Risk of transmission to fetus |
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** |
**Primary and secondary syphilis: 70 to 100% |
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** |
**Early latent syphilis: 40% |
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** |
**Late latent syphilis: 10% |
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==Management== |
==Management== |
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*Antimicrobials |
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*For |
**For primary, secondary, or early latent syphilis: [[Is treated by::benzathine penicillin G]] 2.4 million units IM weekly for 1-2 doses |
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*For tertiary neurosyphilis, treat as usual |
**For tertiary neurosyphilis, treat [[Treponema pallidum pallidum#Management|as usual]] |
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*Monitor response to treatment with RPR serology |
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**Primary, secondary, and early latent |
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***1, 3, 6, and 12 months after treatment; or monthly until delivery, if high risk for reinfection |
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***Primary should decrease 4-fold at 6 months and 8-fold at 12 months |
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***Secondary should decrease 8-fold at 6 months and 16-fold at 12 months |
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***Early latent should decrease 4-fold at 12 months |
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**Late latent: at delivery, 12 months, and 24 months |
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**Neurosyphilis: repeat lumbar puncture every 6 months until parameters normalize |
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***CSF-VDRL titre should decrease 4-fold within a year but may take years to revert to negative |
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*Postpartum, follow guidelines for [[congenital syphilis]] to decide whether and how to treat the neonate |
*Postpartum, follow guidelines for [[congenital syphilis]] to decide whether and how to treat the neonate |
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Latest revision as of 11:54, 27 August 2020
Background
- Risk of transmission to fetus
- Primary and secondary syphilis: 70 to 100%
- Early latent syphilis: 40%
- Late latent syphilis: 10%
Management
- Antimicrobials
- For primary, secondary, or early latent syphilis: benzathine penicillin G 2.4 million units IM weekly for 1-2 doses
- For late latent, latent syphilis with unknown duration, or tertiary syphilis not involving the CNS: benzathine penicillin G 2.4 million units IM weekly for 3 doses
- For tertiary neurosyphilis, treat as usual
- Monitor response to treatment with RPR serology
- Primary, secondary, and early latent
- 1, 3, 6, and 12 months after treatment; or monthly until delivery, if high risk for reinfection
- Primary should decrease 4-fold at 6 months and 8-fold at 12 months
- Secondary should decrease 8-fold at 6 months and 16-fold at 12 months
- Early latent should decrease 4-fold at 12 months
- Late latent: at delivery, 12 months, and 24 months
- Neurosyphilis: repeat lumbar puncture every 6 months until parameters normalize
- CSF-VDRL titre should decrease 4-fold within a year but may take years to revert to negative
- Primary, secondary, and early latent
- Postpartum, follow guidelines for congenital syphilis to decide whether and how to treat the neonate
